1326443870 NPI number — GOSHEN MEDICAL CENTER INCORPORATED

Table of content: DR. MICHAEL DOUGLAS PEACOCK MD (NPI 1104145200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326443870 NPI number — GOSHEN MEDICAL CENTER INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOSHEN MEDICAL CENTER INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326443870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
444 SW CENTER ST
Provider Second Line Business Mailing Address:
PO BOX 187
Provider Business Mailing Address City Name:
FAISON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28341-8820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-267-0421
Provider Business Mailing Address Fax Number:
910-267-8683

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 ADAIR DR STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLDSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27530-4516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-648-4437
Provider Business Practice Location Address Fax Number:
855-269-1567
Provider Enumeration Date:
10/27/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
910-267-8252

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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